Head and Neck Anatomy and Assessment

Head and Neck Anatomy and Physiology

• The head's bony structure includes the Frontal, Parietal, Temporal, Sphenoid, and Occipital bones.
• Key muscles in the face are Frontalis, Temporalis, Orbicularis oculi, Zygomaticus, Buccinator, Masseter, Sternomastoid, and Trapezius
• The major muscle of the neck is the Sternomastoid and Trapezeus Muscle, which provides rotation and flexion of the muscular head.
• Internal jugular vein problems and heart disorders are an important consideration.

Subjective Data Collection for Head and Neck Complaints

• Inquire about the start, duration, type, severity, and location of head and neck pain.
• Visual disturbances like hemianopsia, changes in object shape/size, or unusual eye movements may indicate brain problems
• Determine if any changes in consiousness accompany pain and perform a Glasgow Coma Scale to evaluate
• Ask about other symptoms that accompany pain, such as nausea, vomiting, diarrhea, photophobia, inability to fall asleep, paresthesia, or lack of movement.
• It's important to ask about factors that increase or decrease pain:
  • Factors that increase pain can be fever, fatigue, stress, food, alcohol, seasonal allergies, menstrual cycle, intercourse, oral contraceptives, and caffeine.
  • Sleeping, not using medication, and routine daily medication can reduce pain.
• Certain drugs like anticonvulsives, antiarrhythmics, beta-blockers, calcium channel blockers, oral contraceptives, antidepressants, non-steroid anti-inflammatories, and caffeine-containing drugs can impact head or neck pain
• A loss of consciousness is questioned with dizziness and/or fainting.
  • It is important to follow up on: When, How long, How often, Factors that increase or reduce.
• Ask about any unusual swelling, masses, or nodules in the head and neck, and whether the patient has observed abnormal formations
• Tenderness and pain in the head and neck is important to note (location, type, duration, anything which may cause it to increase or decrease)
• It's important to determine if there is a thyroid issue.
• Thyroid issues can be determined by Swelling in the neck, pain in the touch, pain when swallowing, heat/cold preference, changes in hair/nails/skin, emotional changes, palpitations, and changes in bowel habits
• It's important to know if they take thyroid medication such as Levothyroxine.
• Important to know state of conciousness after reported injury, duration of unconsciousness,
• Inquire about accompanying symptoms like seizures, hypoglycemia, visual issues, syncope, pain, tenderness, lacerations, breathing changes, vision changes, nasal/ear discharge, nausea/vomiting, incontinence or loss of movement.
• Ask about history of head and neck trauma and swelling
• Inquire about related symptoms such as bacterial/viral diseases, fevers, and limitations of the neck and/or head.
• Also inquire about factors affecting function and the impact of certain treatments or medications.
• Important to ask about any personal history relating to head injury, subdural hematoma, lumbar punctures, migraines, vascular headaches, seizures, or thyroid issues
• Important to ask about family history of thyroid and/or headache problems

Social and Personal Information

• Determine how the patient's job, hobbies, and living environment contributes to their head and neck health.
• Important to ask about stress, risk of injury, poor nutrition, and alcohol use

Head and Neck Inspections and Observations

• Examine and document the patient's head position. Note alignment problems.
• In head inspection, evaluate face symmetry and its structure involving the eyebrows, eyes, nose, ears, and mouth.
• Watch raising their eyebrows, smiling, and frowning to evaluate symmetry and cranial nerve function
• Report any muscle spasms on the face and/or neck
• Facial shapes, exophthalmia presence, and their correlation to syndromes are important.
• It is important to distinguish between:
  • acromegaly,
  • Cushing's syndrome (moon face),
  • Myxedema
  • Hyperthyroidism (exophthalmia)
  • Facial paralysis
  • Down syndrome
  • Hydrocephalus

Head and Neck Palpations

• Palpation is important for confirming inspection and data
• The patient needs to be slightly bent forward for evaluation
• Evaluate palpation for sensitivity and mass
• Note the color, structure, distribution, and quality of the hair
  • The presence of dry/dull hair can signigy hypothyroidism while shiny hair can signify hyperthyroidism
• Palpate temporal arteries bilaterally to check for pulse fullness
• Note and report unusual swelling or asymmetry of salivary glands
• Note what position gives optimal view of neck
• Check for shortness, asymmetrical formations, masses, lesions, and excretions
• Evaluate ROM function, pain, difficulty when in movement
• Observe midline alignment of trachea and palpate the hyoid bone, thyroid, and cricoid cartilage for movement/sensitivity
• Palpate the patient's lymph nodes with circulating fingertip movements

Lymph Node and Thyroid Examinations

• Palpate occipital, pre/post auricular, retropharyngeal, submandibular, submental, and supraclavicular regions.
• Palpate the supraclavicular nodes from behind while the patient breathes deeply
• Evaluate the consistency and sensitivity of the thyroid and document the findings.
  • Palpate the thyroid: neck slightly extended, examiner behind, hands on each side of neck.
  • Displace the trachea to evaluate. A palpable thyroid is potentially a problem.
• A normal thyroid gland is non-palpable.
• Investigate any abnormalities within the gland
• This can be caused by: Iodine deficiency, Infection, Autoimmune deficiencies, and Cancer
• Growth of the thyroid can interfere with flow to head and neck areas